Gateshead PCT. Adult Drug and Alcohol Treatment Needs Assessment 2011/2012

Gateshead PCT Adult Drug and Alcohol Treatment Needs Assessment 2011/2012

Contents Executive Summary Page 2-3 Introduction Page 4 5 Current Service Provision Page 6 8 Gateshead Demographics Page 9 12 Demographics of Referrals into Structured Treatment Page 13 22 Prevalence and Unmet Needs Page 23 27 The Treatment System Page 28 41 Harm Reduction Page 42 44 Drug Related Deaths Page 45 47 Reducing Supply Page 48 Crimes under the Influence Page 49 52 Service User Involvement Page 53 Housing Page 54 56 Education, Training, and Employment Page 57 60 Alcohol Page 61 73 Appendices Page 74 1

Executive Summary Problem drug use affects local communities, families and children as well as individual people with drug problems. Problem Drug use in Gateshead Home Office research estimates that Gateshead is home to between 1350 and 1575 users of opiates and/ or crack cocaine. The estimated unmet need (people requiring treatment but not in contact with services) is between 140 and 360 people. Prevalence of opiate and / or crack use is higher than the North East average and also higher than the national average. Who is getting in to treatment? 1375 Adult drug users were in treatment services, of which 1175 were in effective treatment for 12 weeks or more in 2010/11 equating to 6.1 per 1000 population. The number of adult drug users in effective treatment grew by 0.4%. In terms of geographical distribution, the main cluster of drug users in treatment are in Dunston and Teams, Felling, Deckham, High Fell, Bridges, and Saltwell. Dunston and Teams has seen the greatest growth of numbers coming into treatment during 2010/11. Self referral is the common referral route both locally and nationally indicating that there is good information and publicity available around treatment services. There were 318 referrals into treatment in 2010/11, of which 35% had never been in treatment before. The number of referrals decreased by 23% compared to 2009/10. Opiates remain the predominant substance of clients coming into treatment but comparisons for treatment naïve clients shows a narrowing gap between opiates and cannabis Looking across all adult drug users in treatment, heroin is by far the most common primary problem substance and substitute prescribing is the most common type of treatment. Almost two thirds of people in treatment are receiving treatment for more than one problem drug substance with alcohol, benzodiazepines, and cannabis being common substances also. Who is leaving treatment? 263 people left treatment in 2010/11 (20% of those in treatment). 41% completed treatment successfully, which is higher than the regional average but below the national averages. The rate, at which people are 2

Increasing the number of people who leave treatment successfully will be a key area of focus for the coming year and this means looking holistically at a range of factors that contribute to a person being prepared to leave treatment and continue with a drug-free life. Increasing recovery from drug dependence Suitable housing and employment are important to achieving and sustaining recovery and reintegration into the community. There is a need for a qualitative assessment of service users education, skills and employment related needs and a map of provision of projects across Gateshead that service users could access. Service users identified a range of factors that would help to promote recovery including more flexible community services and better links with mental health. Drugs, Alcohol and Crime Drug use, particularly of the class A drugs heroin and crack cocaine, is strongly associated with crime and offending. We know that offenders with drug problems are more likely to commit acquisitive crime, such as burglary, thefts and vehicle crime, to provide funds for their addiction and to be convicted of drug specific crime, such as possession and supply. We have established routes into treatment from the various points of contact with the criminal justice system. Integrated Offender Management programme is now embedded in the Safer Neighbourhoods process and should present opportunities to attract and engage offenders before their substance problem and their offending escalates. 21% of Drug Intervention Programme tests were positive, the vast majority which related to opiates. The presence of alcohol in recorded violence has increased is now present in 51% of all recorded violence. Alcohol was identified as a contributory factor in almost 8% of all recorded crime and drugs was an influencing factor in 5% of recorded crime. Drug Related Deaths There were 21 suspected related deaths between Oct-10 and Sept-11. The drugs used are often a mixture of illicit and prescribed drugs with a trend mixing alcohol and benzodiazepines continuing along with the suspected use of diverting methadone. Since 2008, The Bridges 20, Deckham 14, Felling 9, and Low Fell 6 have had the highest number of deaths giving a clear indication of further promotion of harm reduction messages in these areas. 3

Introduction The Safer Gateshead Partnership is responsible for the co-ordination and delivery of the Drug Strategy 2010. The three key themes of the strategy are: Reducing demand creating an environment where the vast majority it people who have never taken drugs continue to resist any pressures to do so, and making it easier for those that do to stop Restricting supply reducing drug supply through a co-ordinated response across Government and law enforcement Building recovery in Communities working with people who want to take the necessary steps to tackle their dependency on drugs by getting them into treatment and into full recovery and off drugs for good Commissioned services should meet the needs of problematic drug users, their families and carers as well as the wider community. The National Treatment Agency (NTA) has tasked local drug partnerships with producing an annual needs assessment for adult drug misuse to ensure that the priorities included in the adult treatment plan reflect and respond to local need. The partnership will continue to refine the local needs assessment as an ongoing process and study emerging trends and unmet need. A Needs Assessment is a robust systematic process to enable the production of an evidence-based adult drug treatment plan. The needs assessment should be seen as a strategic process which is owned and understood by all stakeholders within the local partnership. The process should also be an integral part of treatment planning, implementation and performance management. In previous years, Gateshead has produced separate needs assessments for Adult Drug treatment and Alcohol. However, with an integrated drug and alcohol treatment service in Gateshead, and the recognition in the drug strategy that many of the challenges and opportunities are common to both drugs and alcohol, it was decided to produce a combined assessment across both elements of delivery. The Substance misuse/alcohol needs assessment is based on analysis of people currently receiving treatment within the treatment services and is not a population based assessment. That information is shown in the 2011/12 Joint Strategic Needs Assessment section 17 and will also be available following analysis of the 2012 Health and Lifestyle survey which is being carried out during February and March 2012. 4

The purpose of the needs assessment is to facilitate an understanding of the needs of the local community, the resources available and the ability of the current treatment system to meet those needs. The NTA criteria for an effective needs assessment process include the identification of: What works among those in treatment and what the unmet needs are Where the system is failing to engage and retain people Hidden populations and their risk profiles Enablers and blocks to treatment pathways Relationship between treatment engagement and harm profiles This needs assessment will be used to develop commissioning priorities for the 2012/13 Substance Misuse/Alcohol Adult Drug Treatment Plan. The priority for alcohol in 2012/13 is to maintain links between the population who are in working communities with people who drink unsafely and work, focused on other people in treatment. This needs assessment for drug treatment is informed by the Joint Strategic Needs Assessment for Gateshead which identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness. The Safer Gateshead Strategic Assessment which provides an overview of the key crime, disorder and anti-social behaviour issues also informs the needs assessment process. In parallel to this process a separate needs assessment is also conducted which focuses on identifying the needs of young people requiring specialist substance misuse treatment. 5

1. Current Service Provision The Adult Joint Commissioning Group, whose membership consists of health, police, probation, local authority, housing and Jobcentre Plus, is responsible for the commissioning and effective delivery of drug and alcohol treatment services that reflect best practice in terms of quality and effectiveness whilst reflecting the needs of the local population. Community Integration Team Gateshead s Community Integration Team, provided by Turning Point, is an integrated team made up of staff from several specialist agencies. The team assists service users to access housing support, relevant training (in preparation for the employment market) and help find employment at the appropriate time. It also supports and signposts service users into community services and activities. Criminal Justice Intervention Team The Drug Intervention Programmes key aim is to get adult drug-misusing offenders who misuse specified Class A drugs (heroin and cocaine/crack cocaine) out of crime and into treatment and other support. NHS South of Tyne and Wear Substance Misuse Services are the lead organisation for the Criminal Justice Intervention team which provide the Drug Intervention Programme. This team also includes staff from North East Council on Addictions and Turning Point. They provide advice, information, assessment and support at arrest and for people leaving prison. Referral to this team is through contact with the criminal justice system. NHS South Tyneside Foundation Trust Substance Misuse Services This is an integrated drug and alcohol treatment service provided by NHS South Tyneside Foundation Trust. It provides specialist treatment and care to people who experience problems with alcohol and/or drugs, by working closely with other health, public and voluntary services. Huntercombe Centre The Huntercombe Centre is a 34 bedded specialised alcohol and drug treatment service. The detoxifcation unit currently provides 14 dedicated beds to assist with stabilisation and/or detoxification for problem drinkers or drug users. North East Council on Addictions (NECA) NECA provide a variety of interventions including (but not limited to) assessment, brief interventions, psychosocial interventions, group work, women s outreach service, community development services. 6

The Cyrenians Oaktrees offers abstinence-based, structured day treatment. They offer a 12 week programme which is full time, although those accessing the services will continue to live in their own home. This gives clients the opportunity to bring their home experiences back to the next day s treatment. They also provide a recovery centre at Cyrenians. Phoenix Futures Phoenix Futures operates a residential rehabilitation facility for up to 37 adults with alcohol and/or drug issues. The service provides a safe supportive and structured environment where residents participate in groups and one-to-one sessions to explore the underlying reasons for their dependency. Gateshead Hospital Alcohol Services Key workers from Turning point and STFT Substance Misuse Services provide advice and on ward referral to structured treatment from the Queen Elizabeth Hospital Gateshead A&E department and admissions to the wards for clients with alcohol addiction. 7

TIER 1 Interventions from general healthcare and other services that are not specialist drug and alcohol services. Tier 1 services offer facilities such as information and advice, screening for alcohol addiction, drug misuse and referral to specialist drug and alcohol services: GP s Ambulance Service Pharmacies Hospital A & E Departments Social Care Agencies TIER 2 Open access drug and alcohol treatment services (such as drop in services) offering facilities such as triage assessment, advice and information and harm reduction by specialist drug and alcohol treatment services: STFT Substance Misuse Service (Harm Reduction Team) NECA Turning Point (Community Integration Team) STFT Substance Misuse Service, Turning Point and NECA (Drug Intervention Programme) Turning Point, STFT Substance Misuse Service (Gateshead Hospital Alcohol Service) TIER 3 Drug and Alcohol treatment delivered in the community by specialist drug and alcohol services offering prescribing, structured day programmes and structured psychosocial interventions: NHS STFT Substance Misuse Service (Community Drug and Alcohol Team) Specialist GP Prescribing NECA Oaktrees (Tyneside- Cyrenians) TIER 4 Inpatient treatment and residential rehabilitation Huntercombe - inpatient detoxification Residential rehabilitation (spot purchase): Phoenix Futures 8

2. Gateshead Demographics Gateshead has a population of 190,800 according to ONS mid year population estimates 2009. It is the second smallest area within Tyne and Wear with South Tyneside the lowest with 152,400 and Newcastle upon Tyne the highest with 284,300. It has more females (97,500) than males (93,300). Figure 2.1 Population by age band 2009 Source: Gateshead JSNA Fig 2.2 Male Population by age band 2009 Source: Gateshead JSNA 9

Fig 2.3 Female Population by age band 2009 Source: Gateshead JSNA Gateshead has a relative high proportion of the population within the following age range 35-44. Most of the females fall into the age group 35-44 and 45-54. Likewise most of the males fall into the age groups 35-44 and 45-54. Social and Environmental context There is a strong relationship between social and economic disadvantage and health outcomes. Communities with low incomes or live in poor housing for example, will typically experience poorer health. The Department for Communities and Local Government has created the 2010 Index of Multiple Deprivation (IMD) to quantify disadvantage across a range of factors. The IMD measures deprivation within 7 domains. Income Employment Health and disability Education, skills, and training Barriers to housing and services Living environment Crime 10

Gateshead is ranked 43 rd out of 326 local authorities in terms of overall deprivation (where 1 is the most deprived). Nine of Gateshead s wards contain Lower Super Output Areas within the most 10% deprived in England. The indices are calculated for each of the 32,482 Lower tier Super Output Areas in England. A Lower Tier Super Output Area (LSOA) is a geographical area which was first used within the 2001 Census. The exact size of each LSOAs varies, but an LSOA covers, on average, a population of 1,500. There are 126 LSOAs in Gateshead. A good measure of average deprivation is the proportion of the population of Gateshead that live within areas that are amongst the 10% or 20% most disadvantaged across England. Fig 2.4 Gateshead Index of Multiple Deprivation Map 2010 Source: Gateshead JSNA The relationships between deprivation and illegal drug use have been highlighted in a number of research studies. The Advisory Council for the Misuse of Drugs report Drug Misuse and the Environment (1998) stressed the following points: Deprivation is associated with the problematic use of particular drugs such as heroin and crack cocaine. Deprivation is linked most strongly with the extremes of problematic use and least with casual, recreational or intermittent use of drugs. 11

Deprivation often means a user is less likely to get care and treatment. The chances of overcoming drug problems are less among people who are disadvantaged. They have fewer positive alternatives and less access to meaningful employment, housing etc. Deprived areas often suffer from greater and more visible public nuisance from drug taking and supplying Poor areas with high unemployment levels can provide an environment where drug dealing becomes an established way of earning money. Deprived areas might, at community level, find it more difficult to deal with drug problems. People living in overcrowded and sub-standard accommodation are more likely to share injecting equipment and more likely to get hepatitis, HIV and Tuberculosis. There is a clear link between problematic drug use and deprivation. However this does not mean all problematic drug users come from deprived areas or backgrounds, but it does indicate that a disproportionate number do. 12

3. Demographics of referrals into structured treatment during 2010/11 Fig 3.1 Referrals by Age Band Source: NDTMS The majority of clients who were referred to the treatment services during 2010/11 are aged 25-34 years old. Comparisons to the previous year show that referrals are increasing from the 35-44 years old age group and decreasing from the 18 24 and 25 34 years old age groups. There are a larger proportion of treatment naïve clients, those for one reason or another who have not accessed services coming in for both the 18-24 years and 45-64 years age bands than clients who have previously been in treatment. Fig 3.2 Referrals by Age bands and referral source Source:NDTMS A high percentage of clients coming into treatment for the first time are coming through non criminal justice system routes with a high number of self referrals. The gap between clients previously in treatment referred through criminal justice and non criminal justice routes is a lot smaller especially in the lower age band groups. 13

Fig 3.3 Referral by Gender type Source:NDTMS Gender split remains in line with the region around the ¾ male to ¼ female proportions as last year Fig 3.4 Referral Sources by Gender type Source:NDTMS Males previously in treatment predominately referred from Carats but treatment naïve clients are predominately self referrals Treatment naïve Females are predominately self referrals and those previously in treatment are mainly referred from other drug services. 14

Fig 3.5 Presenting Substance Source:NDTMS Heroin 54% Cannabis 21% Cocaine 12% Fig 3.6 Presenting substance by client type Source:NDTMS Opiates remain the predominant substance but comparisons for treatment naïve clients shows a narrowing gap between opiates and cannabis 15

Nationally, the number of drug seizures has decreased by approximately 5% in 2010/11 compared to 2009/10. The biggest decreases were noted in the seizure of class A drugs, which fell by 15% in 2010/11; while class C seizures increased by 16%. In Gateshead, there has been a fall in the numbers of individuals claiming to use opiates; while an increase in alcohol and cannabis use by individuals has increased, as reported in the North East Public Health Observatory Trends in Drug Use in the North East report, published in November 2011. It is not known if this change is due to the changing preferences of individuals or if this is as a result of a crack down and reduction in the supply of opiates. The increase in cannabis use and the decrease in heroin use is also reflected in the European Monitoring Centre for Drugs and Drug Addiction s Annual Report 2011, which also reports a sharp drop in the availability of heroin in the UK in 2010/11. This is supported by figures showing a considerable drop in the purity of heroin seized in the UK between 2009/10. Whilst there has been a decline in the use of heroin as first choice drug, it should also be noted that the purity and quantity of heroin coming into the North East has declined which could also play an important part in the changing drug use trend within Gateshead. Drug seizures of heroin and purity needs to be monitored in case heroin availability and purity increase and therefore sees an upward trend in the use of heroin in the area. 16

Fig 3.7 Main Drug use for treatment naïve clients 2004-2011 17

Fig 3.8 Injecting behavior Source:NDTMS The majority of treatment naïve clients referred during 2010/11 have stated they have never injected which could be related to the lower number of heroin users coming into treatment. Fig 3.9 Parental Status Source:NDTMS A high percentage of clients entering treatment are not parents but higher proportion of treatment naïve clients are parents 18

Fig 3.10 Housing status Source:NDTMS There are clients with urgent housing and housing problems who have been in treatment previously. Treatment naïve clients have a reducing need for housing assistance. Fig 3.11 Referrals by Area Source:NDTMS extracts 19

As indicated in previous needs assessments there are still high numbers of clients living in Dunston and Teams, Saltwell, Bridges, Deckham, High Fell, Windy Nook and Whitehills, and Felling. Significant areas of deprivation exist in Gateshead and these areas are ranked within the most deprived areas in Gateshead highlighting the link between deprivation, socioeconomic aspects and substance misuse. North East Ambulance call outs During the period 01/01/2011 to 30/06/2011 there were 140 call outs for drug related overdoses. This information is recorded using postcode sector making it difficult to pinpoint hotspots but the common sector was NE10 8 which includes: Bridges, Pelaw and Hedworth, Wardley and Leam Lane, Windy Nook and Whitehills. Fig 3.12 Ambulance call outs for Drug Overdoses 01.01.2011-30.06.2011 NEAS Callouts for Drug overdoes 01.01.2011 to 30.06.2011 call outs of No. 14 12 10 8 6 4 2 0 NE10 8 NE10 9 Source:NEAS NE8 1 NE9 6 NE10 0 NE11 9 NE8 2 NE8 4 NE8 3 NE11 0 NE9 7 Postcode sector NE9 5 DH3 1 NE16 3 NE17 7 NE21 4 NE21 5 NE21 6 NE16 5 NE39 2 NE40 4 DH3 2 NE16 4 Fig 3.13 Ambulance call-outs for Drug and Alcohol Overdose 2010/11 North East Ambulance Services callouts for Drug and Alcohol overdoses 2010/11 140 120 Number 100 80 60 40 20 7 11 72 68 14 83 19 97 21 10 83 89 16 57 19 8 74 79 18 90 16 18 70 72 0 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Month Source:NEAS "ALCOHOL INVOLVED" "DRUGS INVOLVED" 20

Fig 3.14 Ambulance callouts 2010/11 by Drug Type Source:NEAS Analysis of the referral patterns over the last five years highlight that referrals to treatment services peaked in 2007 and there has been a gradual reduction year on year with the lowest number of referrals during 2011. One of the possible reasons for this is a large number of clients have been in treatment for over 2 years and therefore will not influence referral patterns if they did represent to treatment services. Prevalence estimates suggest there are still potential clients in the community who are not known to treatment services and work needs to continue to engage treatment services with this group. The common referral route is self referrals which have remained fairly high over the last 5 years with numbers starting to fall during the last 2 years. Arrest referral/dip was the main referral source in 2007 but year on year reductions especially during 2011 has seen it fall to provide only a small number of referrals. Further work is required to understand the reasons for this. There has also been a reduction in the number of clients referred from CARAT/Prison. The Gateshead Treatment Map for 2010/11 (see appendix 1) shows there were 318 referrals to structured treatment, a fall of 97 against the previous year. There are been a large reduction from arrest referral/dip and CARAT which mirrors the reduction seen across the service in Gateshead. The number of clients retained in treatment between 2 and 4 years and over 4 years has increased during 2010/11. The number of clients discharged from structured treatment has remain at the same level but there has been more planned exits. Further work will help us to understand when and why patients are being referred on. 21

Key Points Number of referrals to treatment has reduced Males 25 34 predominant client group Self referrals are the common referral source with less referrals coming from criminal justice sources. Main presenting substance is Heroin with a shift towards Cannabis for new clients entering treatment There are fewer clients with injecting behavior entering treatment The majority of treatment naïve clients coming from the Bridges, Felling and High Fell. A high percentage of clients entering treatment are not parents Treatment naïve clients have a reducing need for housing assistance. Recommendations/actions The number of clients coming from criminal justice sources to be investigated further to understand why the numbers coming from this source are falling. Monitor the main substance of use for new clients entering treatment to identify if the trend towards cannabis use continues to outpace heroin use. 22

4. Prevalence and unmet need The prevalence of Opiate and Crack users has been published on the NDTMS website for 2009/10, produced by Glasgow University on behalf of the Home Office. The figures have been produced for the third year covering 2006/07, 2008/09 and 2009/10 and comparisons between all three years help to show where there are any variations between the estimates and also act as a guide to gauge how accurate these figures might be. Fig 4.1 Prevalence estimates 2006/07 to 2009/10 The figures show small increase for opiate/crack users and opiate users compared to 2008/09 estimates unlike the increases seen when compared to the 2006/07 figures. The number of crack users has fallen significantly compared to the previous estimate for 2008/09 and are more in line with the 2006/07. The figures show Gateshead has a higher prevalence of Opiate/Crack and Opiate users than the rest of the North East and England but a lower prevalence of crack users than the North East figure and England. 23

Fig 4.2 Prevalence estimates comparisons 2009/10 Source:NDTMS NDTMS data has been used to apply the NTA s Bulls Eye Technique to examine numbers in treatment in the context of the Glasgow estimate of the prevalence of opiate and/or crack cocaine use for 2009/10. This disaggregates the population accessing treatment into mutually exclusive groups. - Those in treatment at the end of the 2010/11 - Those in treatment during 2010/11 - Those known historically to treatment, but not during 2010/11 A comparison can then be made with the Glasgow estimate to give a sense of the size of the population not accessing treatment. This shows the estimate for the treatment naïve clients, those who for one reason or another have not accessed services. The Glasgow estimate 2009/10 puts the number of Opiate and/or crack users at 1441 with a 95% confidence interval of 1356 to 1575. The estimated number of treatment naïve clients is therefore 227 but 41 of these clients were in contact with DIP during 2010/11 but not with the treatment system. 24

Fig 4.3 The Treatment Bullseye for Opiate/ or crack users in Treatment 2010/11 The treatment bulls eye for Opiate /or crack users in Treatment 2010/11 355 924 222 1114 157 Not known to treatment Source:NDTMS Known to treatment but not treated in last year 133 227 41 Known to DIP not known to treatment In-treatment during last financial year In treatment now The Glasgow estimate 2009/10 puts the number of crack users at 413 with a 95% confidence interval of 281 to 671. The estimated number of treatment naïve crack users is 208. 5 of these clients were in contact with DIP during 2010/11 but not in contact with the treatment system. Fig 4.4 The Treatment Bullseye for crack users in Treatment 2010/11 The treatment bulls eye for crack users in Treatment 2010/11 146 222 205 40 Not known to treatment Source:NDTMS Known to treatment but not treated in last year 19 208 5 Known to DIP not known to treatment In-treatment during last financial year In treatment now 25

The Glasgow estimate 2009/10 puts the number of opiate users at 1362 with a 95% confidence interval of 1293 to 1492. The estimated number of treatment naive crack users is 167 who are not known to the treatment system. 39 clients were in contact with DIP during 2010/11 but not the treatment system. Fig 4.5 The Treatment Bullseye for Opiate users in Treatment 2010/11 The treatment bulls eye for Opiate users in Treatment 2010/11 3545 919 222 1295 146 Not known to treatment Known to treatment but not treated in last year 130 167 39 Known to DIP not known to treatment In-treatment during last financial year In treatment now 26

The Treatment Bullseye for Opiate/ or crack users in Treatment 2010/11 by age bands Source:NDTMS Further analysis highlights that the highest number of treatment naïve clients are from the 25-34 age band and 22 of these are known to DIP. Small Increase of the estimated number of opiate users in Gateshead Large reduction of estimated crack users in Gateshead Prevalence of Opiate users in Gateshead higher than the North East Average There are an estimated 227 Opiate/Crack Users not known to treatment services 41 of these are known to the Drug Intervention Program There are an estimated 99 opiate/crack users who are aged 25-34 year olds not known to treatment services Recommendations/Actions Continue to find methods to encourage treatment naïve clients to engage with treatment services and work with treatment providers to promote the services provided. 27

5. The Treatment System Fig 5.1 Percentage of population in effective treatment 2010/11 *Total Population 153.7 Total Service Users in Area **effective treatment 2010/2011 Population percentage of service users per 100,000 South Tyneside 722 470 191.7 Gateshead 1175 613 283.5 Sunderland 1309 462 Source: Local NDTMS data analysis *1000 ** More than 12 weeks or left in a planned way if less than 12 weeks. Gateshead has the highest percentage of clients in effective treatment with 613 per 100,000 population compared to 470 per 100,000 in South Tyneside and 462 per 100,000 in Sunderland Fig 5.2 Proportion of population in effective treatment 2008/09 to 2010/11 Source: Local NDTMS data analysis 28